To identify differences between patients with cold urticaria and controls, images were collected continuously in real time of all subjects before and after cold hand-immersion tests using the three imaging modalities: laser perfusion, infrared, and polarized light colorimetry. Laser perfusion, infrared, and polarized light colorimetry detected significant differences in dermal cold challenge responses in patients with cold urticaria when compared to controls. Significant associations were found between histamine release, blood flux flow and temperature but not skin color indices.